Evidence mounts on how payments to doctors influences prescribing

According to experts, the equation is simple: payments to doctors affect drug prescriptions. And, as 2014 has unfolded, we have seen more and more evidence of this. For example, just last month, Glaxo SmithKline (GSK) was yet again linked with another scandal concerning the bribing of doctors, this time in Poland. One former sales representative for GSK in the Polish region of Lodz, Jarek Wisniewski, has said that “There is a simple equation. We pay doctors, they give us prescriptions. We don’t pay doctors, we don’t see prescriptions for our drugs.”1

This joins a list of wrongdoings by the company over the past few years, including accusations of bribery and tax evasion in China and, in 2012, the largest healthcare fraud settlement in US history. The company was ordered to pay a $3bn (£1.9bn) fine after pleading guilty to promoting two drugs for unapproved uses and failing to report safety data about a diabetes drug to the Food and Drug Administration (FDA). As a result of these scandals, GSK has decided to change its business practices so that it will stop paying doctors to promote its products through speaking engagements and its sales force will also no longer have individual sales targets.

New evidence from academic research has shed the spotlight on how payments to doctors are having an effect on drug prescriptions. At the beginning of this year, researchers at the University of Washington and the University of California collected data on payments to 334,000 doctors (over half of the doctors licensed in the US) by twelve major pharmaceutical companies using information recorded on the ‘Dollars for Docs’ website, (hosted by independent journalist consortium ProPublica). The research provided clear evidence that transfers of value from pharmaceutical companies to doctors creates conflicts of interest that in turn affect prescribing behaviour.

The main outcome of the research was that there was a clear association between payments and increased numbers of prescriptions. In particular, small payments (i.e. under $1000 for the year) were associated with around twenty additional prescriptions. This figure increases to almost sixty when the transfer of value exceeds $1000. The study also found that the number and amount of transfers declines with the distance between the doctors’ office and the pharmaceutical companies headquarters. The researchers believed that this indicates how drug reps are more likely to target doctors near to where they work and provides further evidence for the connection between payments and prescription figures.

What also stood out from the research was that payments from pharmaceutical companies tilt the balance in favour of prescriptions of their own drugs brands. A clear example of this given in the report is for the cholesterol lowering ‘statin’ drugs Lipitor and Cestor, which are both widely prescribed across North America. Prescriptions for Lipitor are connected with transfers from Pfizer, whereas transfers from Astra Zeneca are associated with more prescriptions for Crestor. If there was no bias in prescribing habits, since both drugs are used to treat the same condition, there should be no link between transfers of value and the choice of drug by doctors. The research also highlighted how generic drugs were less likely to be prescribed where payments from drug companies were being made.

After their analysis of over one billion prescriptions, the researchers concluded that “when a drug company pays a doctor he is likely to prescribe that company’s drug” and they hope that disclosure will help patients to best interpret and understand the medical advice they receive. Across the water, in Europe, this optimising of patient care is seen as the overall goal of recent transparency moves that have come into fruition over the past few years. Pharmaceutical companies are now turning to robust data collection methods for transfers of value relying on well-designed platforms such as BMI SYSTEM’s NAYA software solution.

Ruth Knowles is a freelance science writer who has written articles and press releases on a range of life science and health topics. She received her MSc in Science Communication from the University of the West of England, Bristol.